American Journal of Transplantation
American Journal of Transplantation
5 years ago

IL-7 Receptor Heterogeneity as a Mechanism for Repertoire Change during Post-Depletional Homeostatic Proliferation and its Relation to Costimulation Blockade–Resistant Rejection

Jaclyn R. Espinosa, Victoria A. Bendersky, Todd V. Brennan, He Xu, Allan D. Kirk
Kidney transplant patients treated with belatacept without depletional induction experience higher rates of acute rejection compared to patients treated with conventional immunosuppression. Costimulation blockade-resistant rejection (CoBRR) is associated with terminally differentiated T cells. Alemtuzumab induction and belatacept/sirolimus immunotherapy effectively prevents CoBRR. We hypothesized that cells in late phases of differentiation would be selectively less capable of repopulating post-depletion than more naïve phenotypes, providing a potential mechanism by which lymphocyte depletion and repopulation could reduce the risk of CoBRR. Lymphocytes from 20 recipients undergoing alemtuzumab-induced depletion and belatacept/sirolimus immunosuppression were studied longitudinally for markers of maturation (CCR7, CD45RA, CD57, PD1), recent thymic emigration (CD31), and the interleukin-7 receptor-α (IL-7Rα). Serum was analyzed for IL-7. Alemtuzumab induction produced profound lymphopenia followed by repopulation, during which naïve IL-7Rα+CD57-PD1- cells progressively became the predominant subset. This did not occur in a comparator group of 10 patients treated with conventional immunosuppression. Serum from depleted patients showed markedly elevated IL-7 levels posttransplantation. Sorted CD57-PD1- cells demonstrated robust proliferation in response to IL-7, while more differentiated cells proliferated poorly. These data suggest that differences in IL-7-dependent proliferation is one exploitable mechanism distinguishing CoB-sensitive and CoB-resistant T cell populations to reduce the risk of CoBRR. ClinicalTrials. gov - NCT00565773 This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/ajt.14589

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